How midwives help parents have healthy deliveries

Wednesday, May 1, 2024

[5 MIN READ]

Including midwifery in your pregnancy care can lead to a better labor and delivery experience than not having a midwife.
We explain the difference between an obstetrician and gynecologist (OB/GYN), a midwife and a doula.
In many Providence clinics and hospitals, midwives work alongside OB/GYNs.

One popular television show, “Call the Midwife,” follows the stories of English nurse midwives in the 1950s and 60s as they treat patients and share their lives with them. In the show, many of the births are home births — although the midwives are acutely aware that trends are shifting more toward a hospital birth.

Fast forward 60 years, and midwives are still an important part of the caregiving team for many new mothers. According to the U.S. Government Accountability Office, midwives attended 12% of the births in the U.S. in 2021.

Allison Molinski, CNM, a certified nurse midwife at Providence Mission Hospital in Mission Viejo, California, recently spoke in a Providence podcast about the midwife difference, and why many women choose to have a midwife manage their care.

What is a midwife?

There are three different types of midwives: community midwives (which are sometimes known as “lay” midwives), certified professional midwives (CPM) and certified nurse midwives (CNM). Providence employs only CNMs at its hospitals and clinics.

A certified nurse midwife has both a bachelor’s and a master’s degree in nursing, and they are, in many ways, like a nurse practitioner for low-risk pregnant women. They can prescribe medications and birth control, order lab tests and connect their patients with any needed specialists and resources. Women can also see a nurse midwife for women’s health physical examinations and Pap smears.

According to Molinski, about 95% of American nurse midwives work in a hospital setting, and the rest treat their patients in freestanding birth centers or at their homes.

“We are able to support women if they want an unmedicated birth,” Molinski says, “but of course we’re also there if they want an epidural. It doesn’t matter to us — there is no trophy at the end, other than a baby, of course. If we detect any red flags, then we have the interventions we need at our fingertips. Most of us work in a hospital setting and have easy access to epidurals, Pitocin (which is a medication used to encourage the contraction pattern) and continuous fetal monitoring. All of those obstetric interventions can be managed by nurse midwives.”

How do midwives and doulas work together?

While some people might confuse the functions of midwives and doulas, their roles are very different but complementary, says Molinski.

While a midwife is a maternal health medical professional whose job is to take care of the mother and baby and make sure they’re safe, a doula is an expert at providing labor support.

“Oftentimes we’ll encourage a woman in the prenatal period to interview various doulas out in the community and hire one,” says Molinski. “This person will often show up in early labor to a woman’s home, providing support to both her and her partner. They’re rubbing her back, whispering in her ear and encouraging her to change positions. The doula is also helping to track the contraction pattern and help the patient communicate with her doctor or midwife. We love working with doulas, and we highly encourage all of our patients to hire one.”

How a midwife makes a difference

Midwives are health professionals who take a holistic approach to treating their patients, which means they treat not just the medical issues, but the whole person.

“We have 30-minute prenatal visits which allow us to really get to know each other and build a relationship,” says Molinski. “We want to understand how they are doing emotionally and mentally and where they are spiritually. When we are committed to this relationship, it allows us to guide the women through this journey. I think women find that it’s a very empowering experience. Childbirth is such an incredible opportunity for women to see what they're capable of. And when women are empowered to see what their bodies are capable of, we see decreased rates of postpartum depression. Moms are breastfeeding at higher rates. They’re bonding with their babies better, and it’s a great start to motherhood.”

According to a study published in the Cochrane Database of Systematic Review in 2016, women who received midwife‐led models of care were less likely to experience intervention (such as a cesarean section or forceps delivery), and more likely to be satisfied with their care, than women who received other models of care.

At Providence, midwives often work alongside obstetricians and gynecologists (OB/GYNs), providing maternity care for pregnant women out of the same clinics. They work together as a team to make sure women receive the safest level of pregnancy care and have good health outcomes.

“At Providence Mission Hospital, we have a doctor who stays in labor and delivery 24/7 to be an extra set of hands for a midwife or another physician colleague, should anybody need an extra physician,” says Molinski. “And I also have a physician on call that I can consult with at any point in time. We have 24/7 anesthesia for epidurals as needed, and we have 24/7 neonatal intensive care unit (NICU) services should baby come out and need an extra level of care. What sets Providence apart is the expertise and the collaborative care model that we have across all specialty types.”

Contributing caregivers

Allison Molinski, CNM, is a certified nurse midwife at Providence Mission Hospital in Mission Viejo, California.

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